Smokeless tobacco products in paan can cause cancer, warns an English advisory body.
The National Institute for Health and Clinical Excellence has issued new guidelines aimed at helping people in South Asian communities to stop using smokeless tobacco products, the BBC reported.
NICE says too often people using these products are ignorant that they contain tobacco.
Awareness is also low among health professionals, it said.
And, unlike cigarettes, many smokeless products carry no warnings on packs, it added.
Not only these products contain tobacco, they have as much, if not more nicotine in them as smoked tobacco products do. So, like cigarettes, they are highly addictive, it advised.
They may also contain other unhealthy ingredients such as areca nuts - a mildly euphoric stimulant, known to be addictive and cancer-causing - and slaked lime, a chemical used to make cement, the guidelines said.
It's thought that using smokeless products is one of the main reasons why South Asian women are nearly four times more likely to develop oral cancers than women from other ethnic groups in England, it said.
"We hope that this guidance will inform health professionals of the risks posed by these products, so they can take action by asking patients of South Asian origin if they use smokeless tobacco, making sure they are aware of the health risks, and where appropriate referring people for support to help them stop using these products," said Professor Mike Kelly, director of the NICE Centre for Public Health Excellence.
According to the guidelines, smokeless tobacco products include - Tobacco with or without flavourants: misri India tobacco (powdered) and qimam (kiman); Tobacco with various alkaline modifiers: khaini, naswar (niswar, nass) and gul ; Tobacco with slaked lime as an alkaline modifier and areca nut: gutkha, zarda, mawa.